Healthcare Provider Details

I. General information

NPI: 1245537695
Provider Name (Legal Business Name): ERIN N BORBET L.AC, MSTOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W CENTER ST UNIT 3
VICTOR ID
83455
US

IV. Provider business mailing address

57 BEESLEY LN
VICTOR ID
83455-4721
US

V. Phone/Fax

Practice location:
  • Phone: 612-719-6837
  • Fax:
Mailing address:
  • Phone: 612-719-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004093-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: